Concurrent Review Nurse

This is a fully remote position, open to applicants in Florida.

📋 Description

• Act as a primary contact for providers to guide members through the continuum, educate them about benefits, identify candidates for Care Programs, and offer information regarding network access.

• Assess members in the Hospital, Skilled Nursing Facility, LTAC, and Acute Inpatient Rehab to determine benefit eligibility, medical necessity, and the appropriate level of care using member benefits and InterQual or other medical necessity standards.

• Engage in weekly case reviews.

• Assess the member's discharge status and recognize any additional needs and services that warrant ongoing Care Coordination.

• Work in partnership with Medical Directors, Managers, colleagues, and other departments, including Case Management and Care Partners.

⛳️ Requirements

• A minimum of 2 years of relevant work experience.

• Recent clinical experience (within the last 3-5 years) in a hospital, LTAC, Rehab, or SNF environment evaluating benefit determinations, medical necessity, and appropriate levels of care.

• A related Bachelor’s degree or equivalent relevant work experience in Nursing.

• Current Registered Nurse licensure in the State of Florida and/or Compact State Licensure.

• Experience in one or more of the following areas: home health care, rehab, SNF, utilization review, discharge planning, or case management referrals for acute and non-acute services, outpatient services, and community resources.

• Familiarity with the Healthcare industry and Managed Care; proficient in MS Word and Excel with moderate to heavy data entry required.

• Willingness to travel occasionally within the State of Florida.

🏝️ Benefits

• Medical, dental, vision, life, and global travel health insurance.

• Income protection benefits including life insurance and short- and long-term disability programs.

• Leave programs designed to accommodate personal circumstances.

• Retirement Savings Plan with employer matching contributions.

• Paid time off, volunteer time off, 10 holidays, and 2 well-being days.

• Additional voluntary benefits available, along with a comprehensive wellness program.